tbuckley/cabot-search huggingface dataset:
Abstract 10617: Non-Alcoholic Fatty Liver Disease, Heart Failure, and Long-Term Mortality: Insights From the National Health and Nutrition Examination Survey
Authors: vardhmaan jain, Abdul M Minhas, Ambarish Pandey, Sadiya S Khan, Marat Fudim, Gregg C Fonarow, Javed Butler, Mohammad S Khan
Journal: Circulation (2022)

Objective: To evaluate the association between non-alcoholic fatty liver disease (NAFLD), heart failure (HF), and all-cause mortality. Background: Both NAFLD and HF are increasing in prevalence due to shared risk factors. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 to identify non-pregnant individuals aged ≥20 years with HF and NAFLD and linked with the cause of death data from the National Center for Health Statistics. The associations between NAFLD, HF, and all-cause mortality were assessed using logistic regression and Cox proportional hazard modeling as appropriate. Results: There were 82,358,893 weighted eligible participants of whom 3,833,667 (4.7%) had NAFLD. The mean (SE) age was 51.5 (0.35) years, 45.1% women, 63.0% Non-Hispanic White and 11.8% Non-Hispanic Black. Cardiovascular comorbidities were more common in participants with NAFLD; they were more likely to have hypertension (81.7% vs 53.5%), diabetes (65.1% vs 17.1%), stroke (7.3% vs 4.1%), coronary artery disease (14.9% vs 8.4%), or HF (10.5% v s 3.5%) compared with participants without NAFLD. In multivariate logistic regression models adjusting for age, race/ethnicity and sex, participants with NAFLD were 3.5 times more likely to have HF [aOR, 95% CI: 3.47 (1.98-6.06)]. Older age, male sex, presence of diabetes and coronary artery disease were associated with higher odds of HF in participants with established NAFLD. At the end of the follow-up period, participants with NAFLD had higher all-cause mortality compared with participants without NAFLD [HR(95% CI): 1.93 (1.24-2.99), p&lt;0.001]. Conclusion: In this analysis of US adults, ambulatory participants with NAFLD were ~3.5 times more likely to have HF, and twice as likely to experience mortality compared with participants without NAFLD. Further studies are needed to identify the possible linkage between NAFLD and HF beyond the shared risk factor pathogenesis.
Abstract 10031: Parvovirus Causing Severe Cardiogenic Shock With Recovery
Authors: Crystal L Yan, Nina Thakkar Rivera
Journal: Circulation (2022)

Parvovirus B19 infection is common worldwide with the majority of people infected as young children. Its clinical presentation varies widely depending on the patient’s age and immune competence. Parvovirus B19 infection has been associated with myocarditis; however, its causal mechanism is unclear. A 57 year-old man who recently returned from Bolivia presented after five syncopal episodes. His initial troponin was elevated at 11.2 ng/mL. Electrocardiogram showed third degree heart block with a fascicular escape rhythm at 40 beats per minute. Echocardiogram revealed an ejection fraction of 45-50% and global hypokinesis of the left ventricle. Left heart catheterization showed mild non-obstructive coronary artery disease. His transvenous pacemaker was exchanged for a permanent pacemaker a few days later only to discover a repeat ejection fraction of 15-20%. The patient’s condition progressed to cardiogenic shock requiring inotropic and mechanical support. A comprehensive myocarditis workup was pursued which included a negative full respiratory viral panel, along with negative serum tests for coxsackievirus, hepatitis, human immunodeficiency virus, tuberculosis, syphilis, Lyme disease, strongyloidiasis and fungi. Urine toxicology prior to admission was negative for cocaine. Thyroid function tests were normal. Endomyocardial biopsy showed severe myocarditis with lymphocyte predominance. Staining was negative for fungi, spirochetes, Trypanosoma cruzi, herpes simplex virus, cytomegalovirus, or amyloid. There were no multinucleated giant cells seen on light microscopy. Subsequent PCR of DNA isolated from the biopsy specimen was positive for parvovirus (495 copies/100ng DNA) and Epstein-Barr virus (2046 IU/100ng DNA). His serum EBV viral load was undetectable. His parvovirus IgM level was negative and IgG level was positive. A diagnosis of fulminant parvovirus myocarditis was made. The patient was treated with steroids and five days of IVIG. Repeat echocardiogram showed recovery of his ejection fraction to 50-55%. Our case illustrates a complicated and rare case of fulminant parvovirus myocarditis in a previously healthy and active adult who luckily had recovery of his ejection fraction within 1 month.
Abstract 10558: Association Between Concurrent Use of Diltiazem and DOACs and Risk of Bleeding in Atrial Fibrillation Patients
Authors: Mohammed Shurrab, Cynthia Jackevicius, Peter Austin, Karen Tu, Feng Qiu, Sheldon Singh, Eugene Crystal, Joseph Caswell, Faith Michael, Jason Andrade, Dennis T Ko
Journal: Circulation (2022)

Introduction: Diltiazem is a commonly used pharmacotherapy in patients with atrial fibrillation (AF) with potential for a drug-drug interaction (DDI) with direct oral anticoagulants (DOACs). We aimed to assess the risk of bleeding after co-prescription of diltiazem and DOACs among adults with AF. Methods: We conducted a population-based, nested case-control study in Ontario, Canada. The study population included all patients with AF &gt; 66 years on a DOAC between April 1, 2011-March 31, 2018. Cases were patients admitted with major bleeding (index date). Controls were matched in a 2:1 ratio to cases. We categorized exposure to diltiazem before the index date as: a) current users (diltiazem within 7 days); b) past users (diltiazem within 8 to 90 days); and c) unexposed (no diltiazem prescription or diltiazem prescription &gt;90 days before index date). Conditional logistic regression models were used to examine the association between bleeding and diltiazem co-prescription. Results: Among 86,679 AF patients on a DOAC, we identified 2,766 cases (3.2%) admitted with major bleeding. The median age of AF patients was 80 years (interquartile range 75-85); 48.3% were women. After multivariable adjustment, there was a significant association between major bleeding and current use of diltiazem (adjusted odds ratio (aOR) 1.37; 95% confidence interval (CI) 1.08-1.73, p&lt;0.009) but no significant association between major bleeding and past use of diltiazem (aOR 1.19, 95% CI 0.99-1.42, p=0.06) as compared with the unexposed group (Figure). Conclusions: Among older patients with AF on a DOAC, there was 37% increased odds of current use of diltiazem in those with versus without major bleeding.
Abstract 10288: Lipoprotein(a) and Long-Term Risk of Atherosclerotic Cardiovascular Disease in a US Pooled Cohort
Authors: Nathan D Wong, WENJUN FAN, Xingdi Hu, Christie M Ballantyne, Ron C Hoogeveen, Michael Y Tsai, Joaquim Cristino, Matthew Budoff
Journal: Circulation (2022)

Background: Lipoprotein(a) [Lp(a)] is a common genetic factor associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). There are limited long-term follow-up data from large prospective primary prevention cohorts of the US population, including those with diabetes. Methods: We examined the relation of Lp(a) with ASCVD outcomes in a pooled cohort of five major US prospective studies: the Multiethnic Study of Atherosclerosis, Coronary Artery Risk Development in Young Adults, Jackson, Framingham Offspring, and Atherosclerosis Risk in Communities. Lp(a) levels were examined continuously (per 50 mg/dL) and categorically as follows: &lt;15 mg/dL (reference), 15-29 mg/dL, 30-49 mg/dL, 50-69 mg/dL, and &gt; 70 mg/dL. Cox regression, adjusted for age, sex, race/ethnicity, LDL-C, and other risk factors, examined the relation of Lp(a) levels with total incident ASCVD events (non-fatal and fatal myocardial infarction, stroke, revascularization, and coronary heart disease death) in the pooled cohort overall and among those at low-intermediate (&lt;20%) and high ( &gt; 20%) 10-year risk and in those with diabetes. Results: We included 27,756 persons without prior ASCVD (mean age 51.3 + 12.4 years, 55.0% female, and 35.7% black participants) who had a mean follow-up of 21.1 + 9.9 years for ASCVD events. The table below shows the adjusted hazard ratios (HRs) and 95% confidence intervals for Lp(a) levels in relation to ASCVD events. In the overall sample, a 50 mg/dL increment in Lp(a) was associated with a 26% greater risk and compared to &lt;15 mg/dL those with Lp(a) levels of 15-29 mg/dL, 30-40 mg/dL, 50-69 mg/dL, and &gt; 70 mg/dL had 10%, 31%, 44%, and 30% greater risks of ASCVD events. Relationships were stronger in those with diabetes. Conclusions: Our results demonstrate in a large pooled cohort of US prospective studies relationships of increased ASCVD risk begin above Lp(a) levels of 15 mg/dL, especially in those with diabetes.
Abstract 10563: Differences in Donor-Derived Cell-Free DNA Levels During Allograft Rejections in Hepatitis C Positive Donor Recipient Heart Transplant Patients
Authors: Ahsan Usmani, Dae H Lee, Robby Wu, Tammi Wicks, Joel Fernandez, Jessica Huang, Peter Berman, Jason Feliberti, SIVA KUMAR, Debbie Rinde-Hoffman, Guilherme Oliveira, Benjamin Mackie
Journal: Circulation (2022)

Introduction: Non-invasive quantification of donor-derived cell-free DNA (dd-cfDNA) has recently been shown to correlate with endomyocardial biopsy (EMB) for diagnosis of allograft rejection in heart transplant (HTx) patients. Hepatitis C virus-positive (HCV+) donor hearts are being more utilized with comparable survival outcomes. Hypothesis: The aim of this study is to evaluate the utility of dd-cfDNA monitoring in different types of rejections in recipients of HCV+ donor hearts. Methods: We performed a retrospective review of recipients of HCV+ donor hearts between 2018-2022 with paired dd-cfDNA/GEP and EMB results. The levels of dd-cfDNA/GEP were compared in different rejection types and no rejection for patients using non-parametric comparison. CMR ISHLT ≥ Grade 2R and AMR ≥ Grade 1 from histology were considered as allograft rejection. Results: There were 17 patients who underwent heart transplant from HCV+ donor heart. There was a total of 89 paired samples with dd-cfDNA and EMB. The reason for the biopsy was mostly for routine surveillance (N=68, 76.4%). There was a total of 1 case (1.1%) of grade 2 CMR and 16 cases of pAMR (18%; 10 cases of grade 1, 6 cases of grade 2). Levels of dd-cfDNA were elevated in cases of AMR when compared to no rejection (Median: 0.24% vs. 0.12%, respectively, P&lt;0.001; Figure 1A). There were 57 samples (78%) with dd-cfDNA reference values of &lt;0.12%. In patients with no rejection, dd-cfDNA levels were all below 0.25%. The AUC for elevation of dd-cfDNA and allograft rejection was 0.85 [95% C.I.: 0.72-0.97; P&lt;0.001; Figure 1B]. Conclusions: Non-invasive quantitation of dd-cfDNA levels is elevated in allograft rejection as assessed by traditional microscopy from EMB. There was no false-positive rate of dd-cfDNA in allograft rejection at a threshold of 0.25%. Further studies are indicated to study whether dd-cfDNA levels transiently increase only in the setting of allograft rejection or active hepatitis C viremia at the time of biopsy.
Abstract 10944: Cardiac Magnetic Resonance Derived Left Atrioventricular Coupling Index and Major Adverse Cardiac Events in Patients Following Myocardial Infarction
Authors: Torben Lange, Soeren J Backhaus, Alexander Schulz, Ruben Evertz, Johannes Kowallick, Boris Bigalke, Gerd Hasenfuss, Holger Thiele, Thomas Stiermaier, Ingo Eitel, Andreas Schuster
Journal: Circulation (2022)

Introduction: Recently a novel left atrioventricular coupling index (LACI) has been introduced providing prognostic value to predict cardiovascular events beyond common risk factors in patients without cardiovascular disease. Since data on cardiovascular magnetic resonance (CMR)-derived LACI in patients following acute myocardial infarction (AMI) are scare we aimed to assess and validate the diagnostic and prognostic implications of LACI in a large AMI patient cohort. Methods: 1044 patients following AMI were included. After primary percutaneous coronary intervention CMR imaging and subsequent functional analyses were performed in median 3 days after AMI. LACI was defined by the ratio of the left atrial end-diastolic volume divided by the left ventricular end-diastolic volume. Major adverse cardiac events (MACE) including death, reinfarction or congestive heart failure within 12 months after the index event were defined as primary clinical endpoint. Results: LACI was significantly higher in patients with MACE compared to those without MACE (p &lt; 0.001). Youden Index identified an optimal LACI cut-off of 34.7% to classify patients at high-risk (p &lt; 0.001 on log-rank testing). Greater LACI was independently associated with MACE on univariate regression modeling (HR 8.1, 95% CI 3.4% - 14.9 %, p &lt; 0.001) and maintained independence after adjusting for baseline confounders and left ventricular ejection fraction (LVEF) on multivariate regression analyses (HR 3.1 95% CI 1.0 - 9., p = 0.049). Furthermore, LACI assessment enabled further risk stratification in high-risk patients according to traditionally utilized reduced LVEF ≤ 35 % (p &lt; 0.001 on log-rank testing). Conclusions: Atrial-ventricular interaction using CMR-derived LACI is a superior measure of outcome beyond sole LA or LV volume analyses and EF especially in high-risk patients following AMI.
Abstract 10581: Sustained Increase of Serum Glial Fibrillary Acidic Protein After First St-Elevation Myocardial Infarction
Authors: Jan Traub, Katja Grondey, Tobias Gassenmaier, Dominik Schmitt, Georg Fette, Stefan Frantz, Valerie Boivin-Jahns, Roland Jahns, Stefan Stoerk, Guido Stoll, Martin Weber, Anna Frey
Journal: Circulation (2022)

Introduction: Acute ischemic cardiac injury predisposes for cognitive impairment, dementia and depression. Beyond altered cerebral blood flow and neurohumoral activation, recent positron emission tomography data pathophysiologically suggest acute and chronic neuroinflammation, which is accompanied by astroglial activation, after acute experimental myocardial infarction (MI). Hypothesis: Peripheral serum biomarkers indicating neuronal and glial involvement are altered in the year after first acute MI. Methods: Within the investigator-initiated, prospective, multicenter diagnostic ETiCS study, we quantified serum levels of neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) using ultra-sensitive molecular immunoassays serially in the year after first ST-elevation MI (STEMI). Cardiac magnetic resonance imaging enabled precise detection of infarction volume and ejection fraction. Results: Sufficient biomaterial was available from 45 STEMI patients (aged 28 to 78 years, median 56 years, 11% female). Median serum NfL (quartiles) at hospital admission was 10.6 (7.2, 14.8 pg/ml) and median GFAP 63.8 (47.0, 89.9 pg/ml). Absolute levels of NfL (ρ=0.78; p&lt;0.001) and GFAP (ρ=0.56; p&lt;0.001) correlated to patient age at all time-points. While NfL remained unaltered in the course of one year, GFAP after STEMI increased in the first 3 months after MI with a mean change of +10.6±25.0 pg/ml (p=0.007), and remained elevated after 6 months (+12.4±32.9 pg/ml; p=0.015) and 12 months (+12.6±31.2 pg/ml; p=0.010) compared to baseline. Larger relative infarction volume (ρ=0.41; p=0.009) and higher peak creatine kinase levels (ρ=0.39; p&lt;0.001), but not ejection fraction, correlated to increases of GFAP and NfL, respectively. Conclusions: Our findings suggest subtle glial damage after STEMI which correlates to infarction volume. Further studies need to evaluate the valence of serum GFAP as a peripheral biomarker of cognitive decline after MI.
Abstract 10987: Acute Coronary Syndrome, Depression, and Anxiety in Female Patients
Authors: Kiera Liblik, Ricky Hu, Guillaume Foldes-Busque, Sharon Mulvagh, Tara Sedlak, Jacob A Udell, Natalie Kearn, Amer Johri
Journal: Circulation (2022)

Introduction: Female patients are significantly more likely than male patients to experience symptoms of depression and anxiety post-acute coronary syndrome (ACS), correlated with higher rates of cardiovascular morbidity and mortality. Yet, it is unclear if all female patients are impacted broadly or if specific subgroups of female patients are at elevated risk. We aimed to identify the cardiovascular and psychosocial variables correlated with increased depression and anxiety symptoms immediately post-ACS as well as at 3 and 6-month follow-up. Hypothesis: There is a combination of cardiovascular and psychosocial factors associated with elevated depressive/anxious symptoms (Hospital Anxiety and Depression Scale (HADS) score ≥8 on the depression/anxiety subscales) in female patients post-ACS. Methods: This was a prospective multi-center questionnaire-based clinical research study featuring data from 6 sites across Canada using a logistic regression model to delineate multivariate strength of association. Baseline visit (within 72 hours of ACS) included HADS and a sociodemographic questionnaire. Follow-up visits (3 and 6-months) include HADS, Cardiac Anxiety Questionnaire, new health events, mortality, Short Form-12 Health Survey, and Somatic Symptom Scale-8. Results: A total of 245 patients were included in analysis (Table 1). HADS-A≥8 was associated with increased health anxiety at baseline (OR6.56; p&lt;0.001). Conversely, HADS-D≥8 was associated with low social support at baseline (OR3.35; p=0.005) and 3-month follow-up (OR22.65; p&lt;0.001) as well as previous diagnosis of depression at 3-month (OR22.73; p&lt;0.001) and 6-month (OR5.50; p=0.02) follow-up. Conclusion: We identify key factors associated with symptoms of depression and anxiety post-ACS in female patients. Developing a deeper understanding of the relationship between mental health and ACS will benefit patients by informing intervention and prevention strategies.
Abstract 10482: High Sensitivity Troponin I and Myocardial Injury After Noncardiac Surgery in Cancer Patients: A Prospective Observational Cohort Study
Authors: Todd J Liu, Patrick McCormick, Gregory Fischer, Kay See Tan, jasme lee, David AMAR, Lakshmi V Ramanathan, Carol Chen, Gillian Murtagh, Amanda Blouin
Journal: Circulation (2022)

Introduction: Myocardial injury after noncardiac surgery (MINS) is diagnosed when a postoperative troponin concentration exceeds the 99 th percentile upper reference limit for a presumed ischemic mechanism and is associated with increased perioperative mortality. Our goal was to investigate the prognostic characteristics of MINS in a wide oncologic surgical population using fourth generation (TnI) and fifth generation high-sensitivity (hsTnI) troponin-I assays. Methods: In this prospective cohort of adults who underwent noncardiac cancer surgery, waste blood was collected daily until postoperative day three for TnI and hsTnI. MINS was explored using peak postoperative elevation using three definitions: (1) MINS TnI = TnI (≥ 0.06 ng/mL), (2) MINS hsTnI = hsTnI (≥ 17 ng/L for females or ≥ 35 ng/L for males), or (3) MINS either = either TnI or hsTnI elevation. The association between each MINS definition and the endpoints (30-day mortality, observed to expected length of stay ratio [O:E LoS]) were quantified via logistic and log-linear regression. Results: The incidence of MINS TnI, MINS hsTnI , and MINS either were 4.6%, 9.3%, and 9.5% respectively. In univariable analysis, MINS hsTnI was associated with an increased risk of 30-day mortality with an odds ratio (OR) of 3.30 (95% confidence interval 1.07, 8.57; p=0.039). Similar results were found for MINS either but were not statistically significant for MINS TnI . Cardiotoxic chemotherapy had a 3-fold increased odds of 30-day mortality and a higher incidence of MINS hsTnI (12%) when compared to non-chemo patients (9%). Change in O:E LoS was statistically significantly higher (25%) in patients with MINS hsTnI . Conclusion: In a large oncology cohort, MINS was associated with increased odds of 30-day perioperative mortality. HsTnI assays may be better suited to screen for MINS. The relationship of cardiotoxic chemotherapy to MINS risk warrants further investigation.
Abstract 10998: Pulmonary Artery Pulsatility Measured by Cardiac Magnetic Resonance Imaging in Over 42,000 Participants Reveals Novel Genetic Risk Loci
Authors: Adam L Johnson, Manuel A Morales, Luke T WOOSTER, Rebecca H Li, Sophie L Boerboom, Katrina Ostrom, Haakon Sigurslid, Wanlin Jiang, Wenjie Tian, Ana Zeghibe, Kuldeep Singh, Hanna J Barnes, christian L Lino cardenas, Sujin Lee, Paul B Yu, Clint L Miller, Christopher T Nguyen, Rajeev Malhotra
Journal: Circulation (2022)

Introduction: Pulmonary artery (PA) hemodynamics are important predictors of mortality. However, genetic mechanisms underlying increased PA stiffness in diseases such as pulmonary hypertension are poorly understood, and targeted therapies are limited. Evaluation of PA hemodynamics frequently requires invasive right heart catheterization, limiting large-scale studies. This study leveraged cardiac magnetic resonance (CMR) imaging to non-invasively determine and characterize PA pulsatility, an established measure of pulmonary vascular compliance. Methods and Results: A deep-learning neural network was implemented to determine PA pulsatility, defined as the relative cross-sectional area change from diastole to systole, in 42,774 UK Biobank participants (intraclass correlation 0.94-0.96 compared with human readers). The mean (SD) PA pulsatility was 0.36 (0.11), and pulsatility decreased by 0.035 for every decade increase in age. Reduction in pulsatility by 0.1 was associated with the presence of congestive heart failure (OR 1.55 [95% CI 1.37-⁠1.76]), chronic obstructive pulmonary disease (OR 1.41 [1.29-⁠1.53]), or diabetes (OR 1.18 [1.13-⁠1.23]), and PA pulsatility was associated with increased all-cause mortality (HR 1.13 [1.03-1.23]) after adjusting for age and sex and excluding those with CHF or COPD (Fig A-B). A genome-wide association study of 40,496 participants identified loci on chromosomes 2 (top SNP: rs6738973) and 10 (rs2077218) associated with PA pulsatility at genome-wide significance ( p &lt; 5 х 10 –8 ; Fig C). Integrative fine-mapping analyses identified PKDCC and PLCE1 among likely effector genes. Conclusions: This is the first population-based epidemiologic and genomics study of PA pulsatility. Decreased PA pulsatility is associated with advanced age, increased rates of comorbidities, and higher mortality. The genes PKDCC and PLCE1 are among likely effectors of PA pulsatility and warrant further functional investigation.